Orthopedic Surgeon Time Allocation During the Clinical Encounter

Introduction: The Centers for Medicare and Medicaid Services recently launched “Patients over Paperwork”, an initiative to reduce the burden of documentation. Physician time allocation has been reported within medicine subspecialties, but data is lacking within surgical specialties. The purpose of this study is to determine the amount of time orthopedic surgeons spend on direct patient care compared to administrative tasks. Design: Prospective Observational Time-Motion Study. Main Outcome Measurements: Subspecialties included foot/ankle, hand, adult reconstruction, pediatrics, spine, and sports. Tasks were categorized as administrative or direct patient care. Provider status (independent, with resident, with advanced practice provider), encounter type, and dictation method were also documented. Results: Fifteen surgeons were observed during 1,248 encounters over three days, and time devoted to tasks was recorded. The median duration of direct patient care was 7 minutes and 52 seconds per patient (IQR: 5:10-11:49), compared to a median of 4 minutes and 18 seconds (IQR: 2:20-7:57) for administrative tasks. Orthopaedic subspecialty (p<.0001), provider status (p=.0001), and encounter type (p=.0214) were significantly associated with the percentage of time dedicated to direct patient care. Spine surgeons spent the lowest percentage of time on direct patient care (54%), while foot/ankle and hand surgeons spent the highest (69%) (p<.0001). Surgeons with an APP spent 74% of their time on patient care, compared to 65% for independent surgeons and 59% for those involved in teaching. Post-operative patients received the highest percentage of direct care (70%), whereas workers' compensation patients received the lowest (56%). Conclusions: 30-46% of the surgeon’s time was spent on administrative tasks, while 54-69% was dedicated to direct patient care. With a significant portion of time devoted to administrative duties, there are opportunities to improve efficiency, reduce the administrative burden, increase patient interaction, and enhance healthcare quality. Level of Evidence: Level IV – Prospective observational cohort study. Key Words: Time-motion study, Physician workflow, Administrative burden, Direct patient care, Clinical efficiency